The CHAN collaboration’s progress towards a fully integrated, technologically sophisticated network focused on meeting its membership’s information systems needs is (to date) the most advanced of any site’s yet visited for this project. A centralized and interoperable practice management/EMR system is fully functional in four out of the five network members, with plans to go live in the last site within the next few months. The organization’s health centers cooperate closely and share uniform goals for CHAN’s future. They have already seen benefits from the utilization of the Logician EMR and Millbrook practice management system, including improved medical outcomes, data of better quality and accessibility, more efficient physician workflow, fewer claim denials, and cost reductions. In the paragraphs below we outline key conclusions from the site visit.

Successful collaboration. A key theme to emerge from the New Hampshire site visit was the unusually high degree of collaboration practiced by CHAN members. The network goes to great lengths to obtain member input for all decisions and most votes are unanimous. Lamprey Health Care respondents described the organization as “great to work with&hellip;it’s like a big user group.” Stakeholders agreed that problems are approached from a collaborative angle; the attitude of “How can we fix this together?” prevails. There is a strong organizational commitment to advancing the network’s goals and mission jointly, even when it has meant that one entity (e.g., Lamprey Health Care) must disproportionately bear the risks and sacrifices.

Site visit respondents noted that this organizational cohesion and trust is owed in large part to the wider New Hampshire health care environment. New Hampshire is a small state, sparsely populated, and continually short of funds. Relative to other states, there is little money in New Hampshire’s Medicaid and other safety net programs to compete over. The uninsured and underinsured population is large and geographically dispersed, so CHAN members do not consider themselves to be in competition. Instead, the network health centers report that their best chance for long-term success is to make a joint case that the health care provided by FQHCs is high quality and should be reimbursed by all available funding sources. As one respondent noted, “It’s a small state, so we all see each other on a regular basis&hellip;you don’t want enemies, so we all help each other.”

Expanding collaboration.Within New Hampshire, the network will have to continue to collaborate with various public health entities. For example, CHAN may consider a network approach to participation in the New Hampshire Community Technology Partnership as a means to communicate more effectively with non-CHAN health care and social service providers and enhance the level of services available to their clients. In addition, there exists the powerful potential in New Hampshire to streamline and automate reporting conditions of public health importance through the infrastructure developed both by CHAN and the Technology Partnership. Finally, CHAN may expand to include the two consolidated health centers located in the northern half of the state, which have opted out of participating in CHAN. Technological limitations and geographical distance prevented these centers from joining the network during its inception — their IS infrastructure is less sophisticated than that of the other members, which would have meant poorer system performance, and their location hampers the staff sharing made easy by the south’s short distances. However, these centers still participate in CHAN’s clinical best practices projects and other collaborations. “We keep having discussions with them,” said one CHAN respondent, “and maybe in the future it will work out.”

Moving away from grant dependency.CHAN currently subsists on federal, state, and local foundation grants (which comprise 80% of the total budget), as well as annual member dues and shared fees (which make up the remaining 20%). However, grants are a tenuous and energy-intensive source of funds, and frequently pay for specific initiatives rather than broad overhead costs. Like similar organizations, CHAN applies for grants to conduct projects of interest to network members, but this necessitates a lot of “patch work” budgeting. Member fees are not used for the network’s developmental efforts. “The worst thing about CHAN is the need to constantly try and dig up funds,” said one respondent. “We want to get our message out and help others, but we need money to do that.”

Following from the model in other successful networks, CHAN is fostering consulting and technical assistance relationships with other health center consortia seeking to implement a shared systems infrastructure and applications. CHAN has recently begun work under a contractual agreement with a large CHC network in the Midwest to help with their EMR implementation. CHAN respondents described this initiative as “new turf,” but they indicated that there was great excitement through the network over the project. The partnership is designed, in part, to help CHAN grow its capacity. CHAN staff will assist the Midwest network by sharing their knowledge and experience in successfully implementing a centralized EMR system. Once that network’s system is fully operational, the two organizations will move forward with joint data reporting, sharing best practices, and other initiatives.

Enhancing functionality and customer service.As with any forward-looking organization, CHAN’s leadership is engaged in developing new avenues for program enrichment and revenue generation. CHAN’s philosophy is to use cutting-edge technology as a tool for survival — avant-garde computer applications that improve patient care and cut costs can leverage success with funding agencies. One of the network’s planned endeavors is to involve the patients in their own medical records: Using Kryptiq Corporation’s web-based ChartCatalyst software, patients are able to view their personal file and enter in information about their demographics, medical history, and current health status. The program then transfers the information to the EMR database, reducing redundant patient interviewing.

CHAN respondents noted that all of the network’s needed systems improvements are either currently offered by GE and other vendors, or are scheduled to be released in the near future. In terms of user issues, respondents agreed that decreasing provider workload while maintaining patient care quality was an important goal. As described above, entering patient information through Logician’s desktop protocols during an encounter can be cumbersome for the providers, and CHAN staff are seeking ways to make this process more efficient.

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